Aims of the study: The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic. Methods: We retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated. Results: A total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001). Conclusions: The COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.

Aims: We aimed to evaluate the health-related quality of life (HRQoL) in children with supracondylar humeral fractures (SCHFs), who were treated following the recommendations of the Paediatric Comprehensive AO Classification, and to assess if HRQoL was associated with AO fracture classification, or fixation with a lateral external fixator compared with closed reduction and percutaneous pinning (CRPP).Methods: We were able to follow-up on 775 patients (395 girls, 380 boys) who sustained a SCHF from 2004 to 2017. Patients completed questionnaires including the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; primary outcome), and the Pediatric Quality of Life Inventory (PedsQL).Results: An AO type I SCHF was most frequent (327 children; type II: 143; type III: 150; type IV: 155 children). All children with type I fractures were treated nonoperatively. Two children with a type II fracture, 136 with a type III fracture, and 141 children with a type IV fracture underwent CRPP. In the remaining 27 children with type III or IV fractures, a lateral external fixator was necessary for closed reduction. There were no open reductions. After a mean follow-up of 6.3 years (SD 3.7), patients with a type I fracture had a mean QuickDASH of 2.0 (SD 5.2), at a scale of 0 to 100, with lower values representing better HRQoL (type II: 2.8 (SD 10.7); type III: 3.3 (SD 8.0); type IV: 1.8 (SD 4.6)). The mean function score of the PedsQL ranged from 97.4 (SD 8.0) for type I to 96.1 (SD 9.1) for type III fractures, at a scale of 0 to 100, with higher values representing better HRQoL.Conclusion: In this cohort of 775 patients in whom nonoperative treatment was chosen for AO type I and II fractures and CRPP or a lateral external fixator was used in AO type III and IV fractures, there was equally excellent mid- and long-term HRQoL when assessed by the QuickDASH and PedsQL. These results indicate that the treatment protocol followed in this study is unambiguous, avoids open reductions, and is associated with excellent treatment outcomes. Cite this article: Bone Joint J 2020;102-B(6):755–765.

Objectives: Anatomic variations of the extracranial carotid artery are rare. Persistent primitive hypoglossal artery appears with a reported incidence between 0.03% and 0.2%. We report a case of recurrent transient ischemic attacks originating from proximal internal carotid artery stenosis associated with ipsilateral persistent primitive hypoglossal artery and give a review of the existing literature. Methods: A 78-year-old patient with a medical history of two previous transient ischemic attacks consulted our emergency department with an acute left hemispheric stroke. Intravenous thrombolysis permitted complete resolution of symptoms. Concurrent Computed Tomography (CT) and Magnetic Resonance (MR) angiography revealed an unstable plaque causing 50% stenosis of the left internal carotid artery with a persistent primitive hypoglossal artery dominantly perfusing the posterior circulation, and bilateral hypoplastic vertebral arteries. Results: Uneventful carotid artery stenting using a proximal protection device was performed, and the patient was discharged after 12 days. Six months follow-up was uneventful with a patent stent in the internal carotid artery. Conclusions: Treatment of symptomatic carotid artery stenosis in the presence of persistent primitive hypoglossal artery is challenging. Management should be driven by patients’ co-morbidities, the anatomical localization of the lesions and local expertise. In the case of a high origin of the persistent primary hypoglossal artery, carotid artery stenting with the use of a proximal cerebral protection device is probably the preferred and simplest approach.

Approximately 7% of patients with rectal cancer experience local recurrence within 5 years of curative surgery. A positive circumferential resection margin (CRM) is among the most significant risk factors. Other reported risk factors include histopathologic type, anastomotic leakage, positive distal margins, and more recently, the anterior localization of the tumor. In this retrospective cohort study, we aimed to assess risk factors for local recurrence in our institution, with a focus on tumor localization as an independent negative predictive factor. From 2007 to 2018, all patients with stage II or III rectal cancer were included in this study. Patients underwent neoadjuvant chemoradiotherapy followed by surgical resection with total mesorectal excision. The tumor's anterior or posterior localization was assessed by preoperative endosonography or magnetic resonance imaging. Risk factors for local recurrence were assessed using univariate and multivariate regression analyses. A total of 128 patients were included. The 3-year and 5-year local recurrence rates were 4.7% and 7%, respectively. In univariate and multivariate analyses, the histologic type of a poorly differentiated tumor (P=0.001) and a positive CRM (P=0.001) were correlated with local recurrence. Tumor localization (anterior or posterior) was not identified as a statistically significant factor associated with local recurrence. Positive CRM and a poorly differentiated tumor histological subtype were found to be independent risk factors for local recurrence. In contrast to previous findings, anterior localization was not identified as an independent risk factor for local recurrence in our patient cohort.

Although minimally invasive surgery has significantly reduced the incidence of incisional hernia (IH) in colorectal procedures, the choice of specimen extraction site continues to pose a risk. This study explores how the location of extraction site influences the occurrence of IH in patients undergoing minimally invasive colorectal resections. We conducted a retrospective observational cohort study involving consecutive patients who underwent minimally invasive colorectal resection for colorectal cancer from 2013 to 2021. Patients with open surgery, previous hernia repair, reoperations during the study period or without imaging follow-up were excluded. The primary outcome measured was the CT-proven incidence of IH at the extraction site. A total of 191 patients were analyzed. Among them, 113 patients (59.2%) had a midline extraction site, while and 78 patients (40.8%) had an off-midline extraction. Midline extraction was preferably used during right and transverse colectomy (98% and 100% respectively), whereas off-midline were preferred in left hemicolectomy, sigmoidectomy, and anterior resection (55%, 88%, 95% respectively). Remarkably, the overall incidence of IH at the extraction site was 30.9% for midline extractions compared to 0% for off-midline extractions (p value < 0.001). The mean follow-up duration was of 3.3 ± 2.1 years. Multivariate logistic regression analysis revealed midline extraction as a significant risk factor for IH with a relative risk of 29.1 (95% CI 3.8–220.5, p value < 0.001). The findings highlight a substantial increase in the risk of IH associated with midline extraction sites. As such, it is crucial to advocate for fully minimally invasive colorectal resection using off-midline incision to enhance patient outcomes and reduce the risk of incisional hernias.

Background Non-restorative resection (NRR) is the most common procedure for perforated diverticulitis, but frequently leads to permanent stoma and morbidity related to stoma reversal. For selected patients, primary anastomosis (PRA) is another option. Damage control surgery (DCS) may be an alternative, potentially offering a greater likelihood of stoma-free discharge. We compared DCS to conventional surgical treatment in terms of stoma-free discharge and postoperative complications. Methods This single center trial compared patients treated before and after the introduction of a new treatment algorithm based on DCS. The prospective study group underwent surgery from 2022 to 2024, following implementation of a DCS-based treatment algorithm. The retrospective control group underwent operation from 2020 to 2022 (pre-algorithm). The primary outcome was stoma presence at 12 months. Secondary outcomes included stoma at discharge, complications, length of hospitalization, costs, and complications after stoma reversal. Results In the control group, 29/30 patients (97%) underwent NRR. In the study group, 22/26 (85%) underwent DCS, among these 4/22 (18%) required conversion to NRR, and 18/22 (82%) achieved anastomosis during the second-look. Demographics, length of hospitalization, post-operative complications, and complications after stoma reversal were similar. The control group exhibited higher rates of stoma at 12 months (37% vs. 8%, P = 0.003). Multivariate analysis revealed that treatment before the algorithm was independently associated with increased stoma presence at 12 months (Hazard ratio 10.65, P = 0.013). Conclusions DCS appears to be a safe and effective strategy, yielding significantly lower rates of stoma at 12 months compared to conventional treatment for perforated diverticulitis. Graphical abstract